Food options with ritonavir

Mar 27, 1997

Dear Dr Gallant, It has been suggested that eating a fatty meal such as a
fried
egg with bread would enhance the absorption of
Ritonavir. Another suggestion is to eat a "sandwich-sizes" meal. If I
were to do
this at 0700 in the morning (the time I take
Ritonavir) my kitchen would look like a scene from "The Exorcist" as I
would
start to feel VERY sick VERY fast. Could you
suggest something (like a mouthful of cod-liver-oil or cooking oil) which
would
increase the 'fat' content of much more
edible accompanyments such as a plain bowl of serial. Also do you think
that it
would be a good idea for the body to produce
a regularly updated table of drug cross-resistance so that we can weigh
up our
future options...? In one of your previous
answers you intimated that AZT resistance would occur after about 1 year.
Would
this be the case if it was taken in
combination with other drugs like DDI and Ritonavir? Many thanks again -
Richard

Response from Dr. Gallant

Unlike saquinavir (Invirase), ritonavir (Norvir) does not require fat for
absorption, but the fat can help to diminish some of the side effects.
Personally, if I had to eat a fried egg and bread in order to take my
medications, I'd have to switch drugs. (I'm getting nauseated just
thinking
about it!)

How about a bagel with cream cheese, buttered toast, or a Danish, along
with
cereal with whole milk and a banana? That sounds much better to me. If
you
don't have a lot of side effects, then you don't really need to worry as
much
about the fat content of your food.

As for cross-resistance, your idea of a table would be great if we were
more
certain about this issue, but it's really a moving target. Furthermore,
cross-resistance is not always 100%. 3TC resistant virus MAY be
partially
resistant to ddI and ddC, for example, but it's only partial.

Similarly, while there is complete cross-resistance between indinavir and
ritonavir, the cross-resistance between those drugs and saquinavir or
nelfinavir
is only partial. If you were to present that sort of information in a
table, it
might be misleading.

I'm not sure when I said that AZT resistance took a year. It actually
begins to
occur much sooner than that, although the benefit of AZT may last that
long.
When you combine AZT with other drugs, especially with a protease
inhibitor,
resistance may not occur at all provided it wasn't there to begin with.
That's
because if you suppress replication completely, you can't get mutations,
and
that means no resistance. (That's the idea, anyway.)

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